=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114879624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELBY BALL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2026
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 362 BOARDMAN POLAND RD STE 12
-----------------------------------------------------
City | BOARDMAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44512-4934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-720-7119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2761 GRANDVIEW BLVD
-----------------------------------------------------
City | CANFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44406-9123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-720-7119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | COS.037526
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------